Since 2022, the Center for Advanced Lung Disease and Lung Transplantation at NewYork-Presbyterian and Columbia has followed a protocol that keeps lung donor allografts in a controlled hypothermic organ preservation unit at 10 degrees Celsius — a pivot that not only increased organ preservation time but also dramatically improved operational efficiency. A study recently published in the Journal of Thoracic and Cardiovascular Surgery now validates that this approach produces noninferior patient outcomes when compared with the standard preservation method of keeping donor lungs immersed in preservation solution and triple-bagged under ice in temperatures ranging from 1 to 4 degrees Celsius.
“There’s evidence going back over 30 years ago that the best temperature to preserve lungs was 10 C, although logistically it was never implemented anywhere,” says Frank D’Ovidio, M.D., Ph.D., lung transplant and thoracic surgeon and director of the Ex-Vivo Lung Perfusion Program at NewYork-Presbyterian and Columbia, and senior author of the paper. After a more recent clinical trial in Toronto validated the evidence and proved lungs could remain viable for longer at 10 C, Dr. D’Ovidio and team adopted the temperature as their standard. “As far as we know, we were the first center in the U.S. to implement a hospital-based lung organ preservation unit,” he adds.
There are definite resource benefits, logistics benefits, and treatment benefits for patients, and overall, the outcomes have been extremely favorable.
— Dr. Frank D’Ovidio
The retrospective analysis of 263 consecutive lung transplants, performed at NewYork-Presbyterian and Columbia between January 2022 and July 2024, included 94 patients who received donor organs directly from under ice preservation, and 169 whose allografts had also been stored at 10 C for various lengths of time. The median total preservation time for the under-ice-only cooled cohort was five hours, versus more than 10 hours for the 10 C cohort. As the investigators predicted, there were no observed differences between the two groups in patient outcomes — which included primary graft dysfunction at 72 hours; median number of days on extracorporeal membrane oxygenation support; duration of mechanical ventilation; 30-day, 90-day, and one-year mortality; and overall survival — even in the cohort of patients with an extended total 10 C preservation time (median time of 14 hours).
“There are definite resource benefits, logistics benefits, and treatment benefits for patients, and overall, the outcomes have been extremely favorable,” says Dr. D’Ovidio.
How 10 C Lung Organ Preservation Improves the Clinician and Patient Experience
When ice coolers were the only means of allograft preservation, transplant teams had to rush to begin implantation within four to six hours of procuring the organ, often requiring middle-of-the-night surgeries or the rescheduling of other operations. Preserving lungs at 10 C allows surgeons to delay transplantation for up to 24 hours — the uppermost total preservation time recorded in the study was 22 hours and 49 minutes — and possibly even longer, which helps minimize overnight surgeries.
“It’s well known in the literature that there are more complications in surgeries performed overnight than during the day,” says Dr. D’Ovidio. “Given the acuity of the types of transplants that we do at our center, being able to perform surgeries during the day also means more colleagues and support are available.”
Under traditional methods, patients would also have to be called in on short notice; many times, this would result in patients being sent home if the lungs were deemed inappropriate. But with the added preservation time, patients can stay on standby at home until the procurement team assesses the viability of the donor lungs. When needed, the transplant team also gains more time to perform a prospective crossmatch to determine whether the recipient has antibodies that would attack the donor organs, as well as more time to implement certain procedures prior to transplantation, such as plasmapheresis, that may contribute to transplant success.
The overall improvement in lung preservation and transplant strategy has made the 10 C organ preservation model a new gold standard for us.
— Dr. Frank D’Ovidio
Establishing the 10 C Organ Preservation Model
To set up the in-hospital organ preservation unit, Dr. D’Ovidio and team, in partnership with institutional leadership in perioperative services, quality and patient safety, and transplant operations, established a standard protocol to accept organs in and out of the unit using the same medical refrigeration equipment and processes used in blood and tissue banks. Today, if the patient and transplant team are ready when the organs arrive in a cooler, the allografts can go straight to the operating room for immediate transplantation. But if they arrive overnight or the patient must travel from further away, the lungs are placed in the organ preservation unit at 10 C until the planned surgery. “There is obviously still some urgency to perform the transplant within 24 hours, but doing it in this semi-urgent manner means we now have a workflow where surgeons, anesthesiologists, nurses, and others do not have to be called in in the middle of the night,” he says.
Now that the 10 C organ preservation unit model has become standard practice at NewYork-Presbyterian and Columbia, Dr. D’Ovidio says other transplant centers have been reaching out for guidance to learn how to set up their own. “It does require more of an operational effort, but we have been able to optimize hospital resources and human resources, and provide a better patient experience,” he says. “The overall improvement in lung preservation and transplant strategy has made this a new gold standard for us.”
